Health & Wellness

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Introduction

The Malaysian health and wellness industry has seen significant expansion since the beginning of the 1990s. This trend is set to continue, with the healthcare sector expected to experience average annual growth of 8.4 per cent over the six-year period between 2012 and 2018, rising from MYR6.96 billion to MYR11.29 billion. Accordingly, the government is targeting a rise in public and private expenditure on healthcare, from an anticipated 4.5 per cent of GDP in 2018 to 7 per cent by 2020, thereby bringing spending in line with high-income economies.

As the health and wellness industry continues to expand, increasing focus is turning to human resources in the sector, since talent development is directly linked to the provision of efficient and high-quality health­care.

In this context, International Investor brought together a number of thought leaders from the Ministry of Health and prominent public and private sector healthcare providers, educators and technology experts to discuss the issue of talent development in the industry. The debate was conducted under Strategic Review conditions with focus on pressing topics, including retaining talent in the public sector and in the Malaysian healthcare system in general, increasing the involvement of the private sector in talent development and training, and measuring and improving quality of care through the application of health informatics.

A central proposition of the Strategic Review conversation was the importance of public and private sector collaboration in maximising talent development through training, while ensuring the utmost standards of quality of care. To that end, many of the remarks made by participating public and private sector directors and executives were framed by two key objectives: meeting the ongoing health needs of the country and positioning ‘Malaysia Healthcare’ as a competitive player on the global stage.

Upon conclusion, distinct action points had been devised with regard to specific areas, including forging closer working relations and cross-sector funding to boost education and training, and developing non-clinical career pathways to promote new employment opportunities in the sector.

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“A crucial part of retaining healthcare talent goes beyond attractive remuneration and includes the provision of a working environment conducive to career development. If such working conditions can be secured, the industry will go a long way towards becoming sustainable”.

“It is important to recognise the different models in play between the public and private sector, which are often the direct cause of many of the [problematic] issues. For example, in the private sector doctors essentially act as independent business persons, whereas those in the public sector are government employees”.

“The internal brain drain from the public to the private sector is significant. However, it is crucial that stakeholders also begin to combat the external brain drain of human capital abroad, especially to Singapore”.

“Realigning the focus of the private healthcare sector from its monetary and specialist-centrist approach to one that is more holistic and sustainable will have a tremendous impact on talent development. In turn, this will help to improve quality of care”.

Key Takeaways

The talent brain drain is twofold: internal, from the public to the private sector, and external, from the Malaysian system to other nations.

Medical training is primarily undertaken in the public sector with an internal brain drain occurring towards the private sector once training has been completed.

Consensus that industry leaders need to equalise the imbalance between the public and private ecosystems to retain more talent in the former.

Public-private management of a training fund, which should include tax-deductible contributions, would help engender sustainable talent development.

Cross-sector input in developing a pipeline of specialists is crucial to resolving the problem of supply and demand in this area.

Liberalising the doctor remuneration framework while making working practices more flexible will facilitate public-private cross-fertilisation of professionals.

Innovative career development pathways will help talent retention.

Enhanced and coordinated incentives during the pre-graduate, graduate and postgraduate periods are a crucial part of addressing the external brain drain.

The independent consultant employment model in which private sector special­ists work as independent contractors must be reviewed.

Increased training by the private sector would bolster talent development and relieve the logistical and financial burden on the public sector.

Collaboration and knowledge sharing between the public, private and university sector will foster sustainable talent development.

“The time medical graduates have to wait to begin their housemanship placement is sometimes up to six months or even a year, which is very long. My concern is that the situation is exacerbating the external brain drain and adversely affecting the sustainability of wider talent-development initiatives”.

“It is important to consider that Malaysia has a broad-based need in terms of healthcare. As a result, a balance needs to be struck between providing junior doctors with a wide-ranging education and enabling those who perform well and who have clear goals to excel in their desired specialty”.

“My aim is not only to boost medical tourism but also to contribute to the broader improvement of Malaysian healthcare. To achieve this, it is crucial to overcome long-standing obstacles that are blocking the pipeline of new specialists. The only way to clear these obstacles is through spaces of dialogue”.

Key Takeaways

Certain rigid public health policies should be made more flexible to create an environment that is fully conducive to training.

Training responsibilities should be distributed within the private sector and coordinated by the Ministry of Higher Education.

The university training system provides stakeholders with a working template to implement medical training in the private sector.

Consensus that changes to the housemanship scheme are required, from the waiting period prior to its commencement to that after its completion.

As of 2017, top-performing medical graduates are being fast-tracked through their housemanship placement in approximately 18 months.

To address the prevailing shortage of specialists, the government is increasing the number of scholarships and opening several alternate training pathways.

A government priority is to place specialists in district hospitals, where their shortage is particularly acute.

Improved training and development of nurses will help to stem the external brain drain, which has created a shortage of nursing professionals in Malaysia.

The creation of new posts suitable for graduate nurses is a critical part of efforts to curb the external brain drain and further incentivise the pursuit of this particular career path.

University nursing degrees are reorienting the perception of nursing as a career, although training must provide graduates with more practical skills.

A new nursing structure in which the system is decoupled from the Public Service Department and based on competencies and skills would strengthen the sector.

“A recurring theme in terms of talent development has been the importance of breaking the rigidity in the system that has kept the two sectors apart. This is an important lesson and it is essential that all stakeholders are involved in the convergence of the three key areas: services, training and research”.

“[Given] the shortage of consultants in the country […] I urge stakeholders to jointly devise a national agenda to define the priorities and opportunities in terms of specialists, both national and foreign”.

“In terms of maximising existing resources, one quick win is to appoint established experts in their field as associate professors to private sector institutions, as occurs in the public sector. These experts could then contribute towards the formation of specialist trainees”.

“ICT platforms can be utilised for real-time monitoring and reporting of quality and performance, as well as acting as a highly effective training resource. ICT can help to facilitate efforts by healthcare institutions to combine evidence-based practice with local practice to create new care plans and to adhere to existing ones”.

Key Takeaways

Facilitating the arrival of new foreign specialists to work in Malaysia will help to fill existing gaps and enhance knowledge in both the public and private sector.

The Second Schedule should be re-evaluated to ensure it does not contribute to the external brain drain by incentivising students to complete their studies abroad.

The government has formulated a four-tiered mechanism to oversee the registration of foreign-educated specialists to address talent shortages.

Allowing non-specialist MOs to practise across the private system will enhance the movement of doctors and training proficiency in both sectors.

A framework for specialist training in the private sector needs to be devised and assessed prior to implementation. A working model is offered by IJN.

Not all medical graduates are necessarily committed to a career as a clinical doctor; therefore, new non-clinical pathways are required.

Participants

Hisham is an MD with a master of surgery degree from the National University of Malaysia. He underwent fellowship training in breast and endocrine surgery at the Royal Australasian College of Surgeons and currently serves as senior consultant surgeon in breast and endocrine surgery at Putrajaya Hospital, Malaysia. Hisham has conducted extensive research and co-authored numerous studies on endocrine surgery during his career. He has been in his current post since March 2013.

Awang Bulgiba has a medical degree (MBBS), a masters of public health, and a masters of applied statistics from the University of Malaya (UM), as well as a PhD from the University of East Anglia, UK. He has 28 years of professional experience, including ten years at the Ministry of Health Malaysia. Having held a number of senior positions at UM including deputy dean, director of strategic and global planning, and deputy vice-chancellor (Research & Innovation), he was named provost in 2015.

Sherene has a degree in business studies, specialising in accounting and finance, from the University of Limerick, Ireland, and an MBA from Durham University, UK. She has been CEO of MHTC since January 2015 and leads the agency in positioning Malaysia as the preferred destination for world-class healthcare services. Her extensive experience in marketing, strategy and business development has been crucial in driving the growth of healthcare travel in the country.

Ahmad has a law degree from the London School of Economics and Political Science and a masters in public administration from Harvard University. He has previously held positions in the financial services sector and with Malaysia’s sovereign wealth fund, Khazanah Nasional. *At the time of the Strategic Review, Ahmad was the CEO of Pantai Holdings, responsible for the overall group operations in Malaysia. In May 2017 he became Chief Corporate Officer at IHH Healthcare.

Mohd Azhari has a medical degree (MBBS) from the University of Western Australia and a diploma of fellowship from the Royal College of Physicians and Surgeons of Glasgow, UK. He has also attended the Oxford Advanced Management & Leadership Programme at the University of Oxford. Mohd Ashari has held numerous high-level positions at the National Heart Institute, Malaysia including chief cardiothoracic surgeon and deputy CEO. He has been the group CEO since June 2014.

Rebecca has a degree in government and politics from George Mason University, U.S., and holds an MBA from the University of Missouri – Kansas City. She has approximately 20 years of experience in healthcare information technology with Cerner. Throughout her tenure Rebecca has held a number of different positions and has been responsible for client satisfaction, support, sales and operations. In January 2014, Rebecca was appointed managing director for Cerner Southeast Asia.

Heric has a bachelor of medicine and bachelor of surgery (MBBS) from Kasturba Medical College in Manipal, India. He has been working with the Sabah State Health Department under the Malaysian Ministry of Health for over 25 years, beginning in July 1991. During this period, he has occupied a number of positions in the State Health Department as well as at Queen Elizabeth Hospital in Kota Kinabalu, Sabah. Heric assumed his current responsibilities as Director of the hospital in 2011.

Zaleha has a bachelors in medicine and a masters in obstetrics and gynaecology from the National University of Malaysia (UKM). She also holds a doctorate in medicine from the University of Newcastle upon Tyne, UK and membership of the Royal College of Obstetricians and Gynaecologists. Zaleha has held various senior positions within the medical faculty at UKM, where she is now the dean. She is also the director of UKM Medical Centre and senior consultant obstetrician and gynaecologist.

Nazirah is a consultant rehabilitation physician and the deputy director (clinical) at the University of Malaya Medical Centre. She is also a senior lecturer at the Department of Rehabilitation Medicine within the medical faculty at the University of Malaya (UM). Nazirah has a medical degree (MBBS) and a masters in rehabilitation medicine from UM, and a PhD from the University of Sydney, Australia. She is a member of various professional bodies and has made numerous publications and presentations in her field.

Yee Mun is a qualified accountant with fellowships from the Chartered Institute of Management Accountants, UK and the Certified Practising Accountants body, Australia. He also holds an MBA from the University of Strathclyde, UK. Yee Mun has 30 years of experience in senior management positions and has worked in the healthcare industry for over a decade with the Pantai Hospital Group and Assunta Hospital, in distinct roles including finance director, COO and CEO.